Vermont Advance Directive

Information you will need

• MD Name
• Principal Street Address
• Principal City
• Principal State
• Principal ZIP
• Principal Phone
• Principal Email
• Effective Date
• Specific Condition/Event
• Agent Address
• Agent Relationship
• Agent Cell Phone Number
• Agent Daytime Phone Number
• Agent Evening Phone Number
• Agent Email
• Co Agents
• Alternate Agent (1) Name
• Alternate Agent (1) Daytime Phone Number
• Alternate Agent (1) Evening Phone Number
• Alternate Agent (1) Relationship
• Alternate Agent (1) Cell Phone Number
• Alternate Agent (1) Email
• Alternate Agent (2) Name
• Alternate Agent (2) Relationship

…and 162 more fields in the PDF.

Completed by the agent and the principal.

The form includes a notary acknowledgment, a witness section.